ABSTRACT
BACKGROUND: Aortic stent-graft infections (ASGIs) are associated with significant mortality. We report our experience of two cases of ASGI treated differently and successfully. METHODS: Two patients presented with constitutional symptoms some months after scheduled endovascular repair of aortic aneurysm (EVAR). Patient 1 had an abscess formation around the endograft in continuity with the right groin. Due to patient comorbidities, a conservative treatment was performed. Patient 2 had an abscess formation with air surrounding the stent graft. The patient was treated successfully by endograft removal. RESULTS: Computed tomographic scan follow-up at 6 months from surgery showed no evidence of recurrent infection. CONCLUSION: Despite the recommended treatment of ASGI being surgery, conservative treatment can be performed successfully in patients with high surgical risk, avoiding aortic clamping. We present the first reported case of ASGI due to Streptococcus haemolyticus, the second case due to a fungus, and the second reported case of spondylodiscitis after EVAR.
Subject(s)
Abdominal Abscess/therapy , Anti-Bacterial Agents/therapeutic use , Aortic Aneurysm/surgery , Blood Vessel Prosthesis Implantation/adverse effects , Blood Vessel Prosthesis/adverse effects , Debridement , Device Removal , Prosthesis-Related Infections/therapy , Stents/adverse effects , Abdominal Abscess/diagnostic imaging , Abdominal Abscess/microbiology , Aged , Aortography/methods , Blood Vessel Prosthesis Implantation/instrumentation , Candida albicans/isolation & purification , Discitis/etiology , Enterobacter cloacae/isolation & purification , Humans , Male , Propionibacterium/isolation & purification , Prosthesis-Related Infections/diagnostic imaging , Prosthesis-Related Infections/microbiology , Streptococcus/isolation & purification , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A 79-year-old man with a 6-cm juxtarenal abdominal aortic aneurysm was treated by endovascular means with a fenestrated stent graft. The completion angiogram revealed a left renal artery occlusion. A retroperitoneal surgical approach allowed for retrograde catheterization of the occluded covered stent through the left renal artery. The covered stent was reopened by balloon angioplasty. After 2 months, the left renal artery was patent and renal function normal. At 6 months, both renal arteries were fully open on duplex imaging. The open retroperitoneal approach with retrograde catheterization is a bailout technique to avoid loss of a kidney in fenestrated stent grafting.
